Experts warn against alternate vaccination schedules

For several years now, alternative vaccine schedules have been touted as an option for parents who worry about the impacts and side effects of the immunization schedule currently recommended for infants and children.

Numerous organizations have spoken out against such schedules, and the American Academy of Pediatrics (AAP) recently released a series of statements on vaccine hesitancy that specifically address the dangers of alternative schedules.

Amanda Cohn, MD, a pediatrician and senior advisor for vaccines at the Center for Disease Control and Prevention (CDC) National Center for Immunization and Respiratory Diseases, said alternative vaccine schedules can be particularly harmful to vulnerable populations.

“Infants and young children who follow immunization schedules that spread out shots—or leave out shots—are at risk of getting sick,” Cohn, who is also executive secretary of the Advisory Committee on Immunization Practices (ACIP), told Medical Economics. “Several vaccine-preventable diseases remain common in the United States, and children may be exposed to these diseases during the time they are not protected by vaccines. This places them at risk for serious illness that might cause hospitalization or death.”

While practitioners may be tempted to follow an alternative vaccination schedule for parents who are hesitant to have their child vaccinated, they need to stress to parents the importance of adhering to the guidelines.

“Following the recommended immunization schedule is the best way to protect babies against 14 serious diseases before they turn two. It’s important to stress to parents that the vaccination schedule is designed to protect infants and children by providing immunity early in life, before they are exposed to life-threatening diseases,” Cohn said.

Provider recommendations are one of the top motivators for vaccine compliance, as evidenced in several studies, and Cohn said physicians can help clear up all the conflicting information circulating about immunization.

“As a mother and pediatrician, I understand that there is lots of information that can be confusing to parents about immunizations, so it is important that parents have access to clear and accurate information about the safety and effectiveness of vaccines,” Cohn said.

The controversy over alternative schedules

Alternative vaccination schedules emerged in the last decade over fears that childhood vaccination contributes to autism or poses a number of other risks. In 2007, Robert Sears, MD, published a book recommending two alternative immunization schedules for vaccine-hesitant parents and he maintains a website promoting these schedules even today. His argument, according to these guides, is that spacing out vaccines lowers the potential for negative side effects. Sears’ theories, however, have been widely denounced by leading public health and vaccine experts.

According to a 2016 AAP report, the number of pediatricians who encountered a parent who refuses vaccines for their child increased from 75% in 2006 to 87% by 2013. The number of parents refusing one or more vaccines for their child increased from 9% to 17%, according to AAP.

The report, and other resources from AAP, recommend that pediatricians may even—as a last resort—dismiss families who refuse vaccination from their practice, effectively “firing” them as patients. Almost 12% of pediatricians reported dismissing families who refused vaccines from their practice by 2013, up from 6% in 2006.

Kathryn M. Edwards, MD, a pediatrics professor at Vanderbilt University in Nashville, Tennessee, and an expert in pediatric vaccinology, helped author the AAP report and said there is no data to support the use of alternative schedules for vaccination, and that the efficacy of the vaccines administered over an alternative course is uncertain.

“For vaccines to be licensed, they have to be administered and studied in a very specific way. The reason vaccine schedules are designed as they are is to provide the best benefit at the earliest possible time,” Edwards said. “The use of alternative schedules has not really been evaluated.”

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